When is prior authorization needed?
Security Health Plan requires prior authorization for some medical services or equipment. While a provider will generally make these requests and submit the necessary forms, it is a member’s responsibility to make sure the process is followed. A health care provider may contact Security Health Plan to determine whether a prior authorization is required for a member’s service or medical equipment by calling our Provider Assistance Line at 1-800-548-1224. Click here to view a list of services that require prior authorization.
Durable medical equipment
All services for durable medical equipment and prosthetic-orthotic services will require prior authorization from Northwood, Inc.
Security Health Plan has partnered with Northwood, Inc., to manage all durable medical equipment and prosthetic-orthotic services. Your provider will work with Northwood to ensure that authorizations are in place for products and services you receive. Below are a few services that require prior authorization and need follow-up with Northwood.
- durable medical equipment
- prosthetic-orthotic services
Medical benefit drugs
Medical benefit drugs (covered by Part B for members with Medicare) are injected or infused while you are in a provider's office, a hospital outpatient or ambulatory surgical center and may require prior authorization. In addition, home infusion services may also require prior authorization.
Home infusion drugs
Skilled nursing services that require prior authorization
acute rehabilitation admission
long-term acute care admission
skilled nursing facility admission
High-end imaging services that require prior authorization
For all high-end imaging and radiation oncology services, you will need to work with your provider to receive prior authorization from eviCore healthcare.
For high-end imaging
Fax an eviCore request form (available online) to 1-888-693-3210
For radiation oncology